Organized Inpatient (Stroke Unit) Care for Stroke
2013; Lippincott Williams & Wilkins; Volume: 45; Issue: 2 Linguagem: Inglês
10.1161/strokeaha.113.003740
ISSN1524-4628
Autores Tópico(s)Healthcare Systems and Practices
ResumoHomeStrokeVol. 45, No. 2Organized Inpatient (Stroke Unit) Care for Stroke Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBOrganized Inpatient (Stroke Unit) Care for Stroke Peter Langhorne, PhDon behalf of the Stroke Unit Trialists' Collaboration Peter LanghornePeter Langhorne and on behalf of the Stroke Unit Trialists' Collaboration Originally published24 Dec 2013https://doi.org/10.1161/STROKEAHA.113.003740Stroke. 2014;45:e14–e15Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: January 1, 2013: Previous Version 1 BackgroundOrganized stroke unit care is a form of care provided in hospital by nurses, doctors, and therapists who specialize in looking after patients with stroke and work as a coordinated team. This care has been provided in different ways, including: (1) a ward dedicated to patients with stroke; (2) through a mobile stroke team; or (3) within a generic disability service (mixed rehabilitation ward).ObjectivesThis update review aimed to assess the effect of stroke unit care when compared with alternative forms of care for people after a stroke.Search MethodsWe searched the trial registers of the Cochrane Stroke Group (January 2013) and the Cochrane Effective Practice and Organisation of Care Group (January 2013), MEDLINE (2008 to September 2012), EMBASE (2008 to September 2012), and CINAHL (1982 to September 2012). In an effort to identify additional published, unpublished, and ongoing trials, we searched 17 trial registers (January 2013), performed citation tracking of included studies, checked reference lists of relevant articles, and contacted trialists.Selection CriteriaWe included only randomized controlled clinical trials comparing organized inpatient stroke unit care with an alternative service. After formal risk of bias assessment, we have now excluded quasi-randomized trials that were previously included.Data Collection and AnalysisTwo review authors initially assessed eligibility and trial quality. We checked descriptive details and trial data with the coordinators of the original trials. The primary outcomes were death, death or institutional care, and death or dependency (Rankin score, 3–6) at the end of scheduled follow-up.Main ResultsWe included 28 trials, involving 5855 participants who compared stroke unit care with an alternative service. More organized care was consistently associated with improved outcomes. Twenty-one trials (3994 participants) compared stroke unit care with care provided in general wards. Stroke unit care showed reductions in the odds of death recorded at final (median 1 year) follow-up (odds ratio, 0.87; 95% confidence interval, 0.69–0.94; P=0.005), the odds of death or institutionalized care (odds ratio, 0.78; 95% confidence interval, 0.68–0.89; P=0.0003), and the odds of death or dependency (odds ratio, 0.79; 95% confidence interval, 0.68–0.90; P=0.0007; Figure). Sensitivity analyses indicated that the observed benefits remained when the analysis was restricted to securely randomized trials that used unequivocally blinded outcome assessment at a fixed period of follow-up. Improved outcomes with stroke unit care were independent of patient age, sex, initial stroke severity, or stroke type, and seemed to be better in stroke units based in a discrete ward. There was no indication that organized stroke unit care resulted in a more prolonged hospital stay.Download figureDownload PowerPointFigure. Organized inpatient (stroke unit) care vs general medical wards. The figure shows the odds ratio (OR; 95% confidence interval [CI]) for the combined outcome of death or dependency in activities of daily living at the end of scheduled follow-up (median 1 year after stroke) together with several patients who had outcome events of the total number randomized to stroke unit or general ward. Results are presented for subgroups of service categorized as comprehensive stroke wards (acute care plus rehabilitation), rehabilitation stroke wards (rehabilitation care only), mobile stroke team (peripatetic team), mixed rehabilitation ward (included some patients without stroke). The diamond indicates the estimated OR (95% CI) for each subgroup (subtotal) and for all services together (total).Author's ConclusionsThis update confirmed that patients who receive organized inpatient care in a stroke unit are more likely to survive and to be, independent and living at home 1 year after the stroke. The benefits were most apparent in units based in a discrete ward. There was no systematic increase in the length of hospital stay. The observed benefit is sufficiently large to warrant efforts of widespread implementation of stroke unit care. Further research is needed to understand the key components and how best to implement such care (especially in low-income settings).This article is based on a Cochrane Review published in The Cochrane Library 2013, Issue 9 (see www.thecochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and The Cochrane Library should be consulted for the most recent version of the review.DisclosuresNone.FootnotesThe full text of this review is available in The Cochrane Library (for subscribers http://dx.doi.org/10.1002/14651858.CD008076). The full article should be cited as: Langhorne P, on behalf of the Stroke Unit Trialists' Collaboration. Organized Inpatient (Stroke Unit) Care for Stroke. Cochrane Database Syst Rev. 2013. Issue 2.Correspondence to Peter Langhorne, PhD, Academic Section of Geriatric Medicine, Level 4, Walton Bldg, Royal Infirmary, Glasgow G4 0SF, United Kingdom. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By Gittins M, Vail A, Bowen A, Lugo-Palacios D, Paley L, Bray B, Gannon B and Tyson S (2020) Factors influencing the amount of therapy received during inpatient stroke care: an analysis of data from the UK Sentinel Stroke National Audit Programme, Clinical Rehabilitation, 10.1177/0269215520927454, 34:7, (981-991), Online publication date: 1-Jul-2020. Ouyang M, Zhang Y, Wang X, Song L, Billot L, Robinson T, Lavados P, Arima H, Hackett M, Olavarría V, Muñoz-Venturelli P, Middleton S, Watkins C, Pontes-Neto O, Lee T, Brunser A and Anderson C (2020) Quantifying regional variations in components of acute stroke unit (ASU) care in the international HeadPoST study, Journal of the Neurological Sciences, 10.1016/j.jns.2020.117187, 419, (117187), Online publication date: 1-Dec-2020. Asgedom S, Gidey K, Gidey K, Niriayo Y, Desta D and Atey T (2020) Medical complications and mortality of hospitalized stroke patients, Journal of Stroke and Cerebrovascular Diseases, 10.1016/j.jstrokecerebrovasdis.2020.104990, 29:8, (104990), Online publication date: 1-Aug-2020. Meyer M, Teasell R, Kelloway L, Meyer S, Willems D and O'Callaghan C (2017) Timely access to inpatient rehabilitation after stroke: a qualitative study of perceived barriers and potential solutions in Ontario, Canada, Disability and Rehabilitation, 10.1080/09638288.2017.1377296, 40:26, (3120-3126), Online publication date: 18-Dec-2018. Anåker A, Heylighen A, Nordin S and Elf M (2016) Design Quality in the Context of Healthcare Environments: A Scoping Review, HERD: Health Environments Research & Design Journal, 10.1177/1937586716679404, 10:4, (136-150), Online publication date: 1-Jul-2017. 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Nouh A, McCormick L, Modak J, Fortunato G and Staff I (2017) High Mortality among 30-Day Readmission after Stroke: Predictors and Etiologies of Readmission, Frontiers in Neurology, 10.3389/fneur.2017.00632, 8 Gittins M, Lugo-Palacios D, Vail A, Bowen A, Paley L, Bray B, Gannon B and Tyson S (2020) Delivery, dose, outcomes and resource use of stroke therapy: the SSNAPIEST observational study, Health Services and Delivery Research, 10.3310/hsdr08170, 8:17, (1-114) February 2014Vol 45, Issue 2 Advertisement Article InformationMetrics © 2013 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.113.003740 Manuscript receivedOctober 24, 2013Manuscript acceptedNovember 20, 2013Originally publishedDecember 24, 2013 Keywordsrehabilitationmeta-analysisoutcome measuresPDF download Advertisement SubjectsTreatment
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